Rep. Glenn Grothman

Maddy summaryHR 5107, the Pandemic Unemployment Fraud Recoupment Act, extends the statute of limitations for enforcing fraud related to pandemic unemployment benefits from 3 years to 10 years across multiple programs, including Pandemic Unemployment Assistance, Federal Pandemic Unemployment Compensation, and Lost Wages Assistance. It requires states to recover overpayments from individuals who knowingly received benefits they weren’t entitled to, through deductions from future unemployment benefits, while maintaining existing due process protections like hearings before repayment. States may waive repayment if the overpayment wasn’t the individual’s fault or if repayment would be unfair. The bill applies directly to individuals who received pandemic-era unemployment benefits through fraudulent means, ensuring states have a longer timeframe to address these cases under established fraud procedures.

Maddy summaryThis bill simplifies participation in Medicare's Accountable Care Organization (ACO) program by removing distinctions between small and large ACOs and eliminating the requirement for new ACOs to assume financial risk for three years before joining shared savings models. It creates a new "100% shared savings" option where ACOs keep all savings from cost reductions but bear full financial responsibility for losses. The bill also mandates clearer, transparent benchmark calculations for ACO performance, establishes appeal processes for disputed benchmarks, and requires technical assistance for rural and underserved providers. These changes directly affect Medicare ACOs, particularly smaller or newer organizations in rural or safety-net settings, aiming to make value-based care participation more accessible.

Maddy summaryThis bill amends the Affordable Care Act and Medicaid/CHIP programs to deny health insurance subsidies, coverage, and related benefits to individuals with Deferred Action for Childhood Arrivals (DACA) status. Specifically, it excludes people lawfully present only due to the 2012 DHS memo granting deferred action from eligibility for ACA subsidies, Medicaid, and the State Children's Health Insurance Program (CHIP). The bill requires states to remove DACA recipients from enrollment in health plans and rescind any existing waivers that allowed such coverage. It directly affects approximately 800,000 DACA recipients who currently qualify for ACA subsidies and Medicaid/CHIP under existing rules.

Maddy summaryHR 4752 (the CHANGE Act of 2023) requires Medicare to include standardized cognitive impairment screening during annual wellness visits and initial preventive physical exams for beneficiaries starting in 2024. It mandates doctors use National Institute on Aging-approved tools to detect memory issues and document results in medical records. This directly affects Medicare patients aged 65+ and their healthcare providers, aiming to enable earlier Alzheimer’s diagnosis and care planning. The bill focuses on making routine screenings a standard part of Medicare-covered checkups, not on funding or new programs. It does not alter existing Medicare benefits but adds a specific screening requirement to two existing service categories.

Maddy summaryThis bill prohibits federal funding for gender transition procedures - including hormone therapy, puberty blockers, and surgeries like genital reassignment - across all federal programs and health plans. It exempts procedures for medical conditions (such as disorders of sex development) and treatment of complications arising from such procedures. The bill also blocks Affordable Care Act premium tax credits and cost-sharing reductions for health plans covering these services, though individuals may purchase separate non-federal-funded coverage. State and private insurers can still offer such coverage using their own funds, but federal subsidies cannot be applied to it.

Maddy summaryHR 3227, the Ensuring Seniors’ Access to Quality Care Act, amends Medicare and Medicaid rules to address nurse aide training programs in nursing facilities. It allows the Secretary of Health and Human Services to disapprove a facility’s nurse aide training program for up to two years if the facility received a $10,697+ civil penalty for substandard care and hasn’t corrected the quality issues. Facilities can have disapproval lifted by proving they fixed the care deficiencies, haven’t had recent patient harm incidents, and the penalty didn’t involve immediate patient jeopardy. The changes apply only to penalties assessed after the bill’s enactment and do not affect facilities already prohibited under prior rules.

Maddy summaryThis bill changes tax rules to treat direct primary care (DPC) membership fees as deductible medical expenses. It defines DPC as a fixed monthly fee (capped at $150 per person, $300 for families) for primary care services only, excluding procedures requiring anesthesia, prescription drugs (except vaccines), or lab tests. The law ensures these fees can be claimed on tax returns like other medical costs, while clarifying DPC arrangements aren’t considered health insurance plans. It applies to fees paid for DPC services provided through employment or directly to patients, effective for 2024 tax years.

Maddy summaryThis bill regulates pharmacy benefit managers (PBMs) working with Medicare Part D prescription drug plans. It prohibits PBMs from earning income based on drug prices or rebates (requiring flat fees instead), mandates equal reimbursement for all network pharmacies, and requires PBMs to report how much of drug rebates they pass through to Medicare plans. The law also mandates annual compliance certifications and requires the government to publish aggregated transparency data (without revealing specific plan details) starting in 2024. These changes directly affect Medicare Part D plans and the seniors who rely on them for prescription drug coverage.

Maddy summaryThe I CAN Act (Improving Care and Access to Nurses Act) expands healthcare access by removing barriers for nurse practitioners, clinical nurse specialists, physician assistants, certified registered nurse anesthetists, and certified nurse-midwives within Medicare and Medicaid programs. Key provisions include allowing these professionals to provide cardiac and pulmonary rehabilitation services, prescribe certain diabetic shoes, and deliver hospice care without unnecessary physician supervision. The bill also clarifies reimbursement for services provided by certified nurse anesthetists and improves access to home health services through certified nurse-midwives. These changes directly affect Medicare and Medicaid beneficiaries by potentially increasing access to care and healthcare providers by expanding their scope of practice. The bill aims to improve healthcare delivery by leveraging the skills of advanced practice nurses across multiple care settings.

Maddy summaryHR 1783, the Senior Independence Act of 2023, increases the annual earnings limit for Social Security early retirees. It raises the monthly exempt amount from $1,970 (under current law) to $2,500 for 2024, allowing people collecting benefits before full retirement age to earn more without having their monthly payments reduced. This change applies to taxable years ending after 2023, with future adjustments for wage inflation. The bill directly affects early retirees who continue working, enabling them to keep more of their earnings while retaining Social Security benefits.